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i <br /> PAd_OF . <br /> MONITORING WELL INSTALLATION REPORT <br /> ( 2 CONSTRUCTION <br /> Date: <br /> premise Address: �$?�� J . <br /> Well No <br /> yds . Total Depth 26 <br /> Inspector' Screen Length <br /> Fitter Pack <br /> Bentonite Pellets' <br /> Grout <br /> Permit No. Completion-Stove pipe/christie box <br /> Consultant <br /> Geologist tr�.viK P° � <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING +sock-up <br /> Folding T_emoerature� TAS <br /> Method <br /> Sc-wing Method_— A50yB-GROUND CNAISTY-Box <br /> MPLETION COMPLETION <br /> Tracking Sheet (y/n) .------ Gnx:ndswfacs <br /> SPOILS prall <br /> ft. <br /> ' Storage Method <br /> Contamination Noted - yes/no I. <br /> Storace Locations n' r— <br /> Domestic <br /> SPECIAL PERMIT INFO. sac�onDistance to sewer lire well on site - yes/nopack <br /> If yes, location & distance n. I <br /> GROUTING MATEFtI�USED., <br /> Casing type <br /> Depth to water — <br /> Blank ft Screen <br /> M4x Ratios Slot size <br /> Installation Method _____— Bags cement <br /> Quantity Installed �--- Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> :)tal Billed Time Per Site <br /> ite Permit Finalized <br />